Published: August 2026. Next review: 2031.
Musculoskeletal conditions are one of the largest and fastest growing contributors to demand on NSW public health services.
In NSW, a person’s pathway into orthopaedic care varies, resulting in:
- inconsistency in referral pathways
- long wait times
- fragmented care
- inequitable access to conservative care
- avoidable pressure on surgical services.
Strengthening consistent ‘conservative-first’ pathways enables local health districts (LHDs) and specialty health networks (SHNs) to improve patient outcomes, support system sustainability and ease pressure on surgical services.
Our Scoping Pathways into Orthopaedic Care project identified opportunities to strengthen conservative-first care across NSW. Findings from 61 surveys and site interviews highlighted that existing high-performing models provide a foundation for broader adoption.
Why change is needed
- Demand continues to grow: musculoskeletal (MSK) conditions drive substantial planned surgery and outpatient activity.
- Pathways are inconsistent: referral processes vary widely, across and within districts. Many patients are still referred directly to surgeons, despite evidence supporting conservative care.
- Conservative care is underused and overstretched: programs like the Osteoarthritis Chronic Care Program (OACCP) deliver strong outcomes, but are limited to specific cohorts (hip and knee), accessed only after patients are waitlisted for surgery.
- Surgical-first mindset persists: many referrals bypass allied health triage, reducing opportunities for conservative care, education, self-management and shared decision-making.
- Workforce and governance barriers limit consistency: short-term funding, limited data infrastructure and variable uptake of Statewide Referral Criteria (SRC) reduce the ability of services to scale high-value care.
- Equity gaps remain significant for rural communities, Aboriginal people and priority populations.
Why strengthening conservative care matters
A consistent conservative-first approach delivers clear benefits for patients, clinicians and system performance.
- Holistic, multidisciplinary conservative models support pain reduction, physical function, health literacy and readiness when surgery is required.
- Longer consults and shared decision-making improve satisfaction and trust.
- Allied health-led triage models reduce unnecessary surgical appointments and decompress specialist clinics.
- Some programs using a single front-door triage process show between 50–70% of patients can avoid surgery with appropriate conservative care.
- Early conservative care reduces inappropriate imaging, surgery-first pathways and avoidable surgical demand.
- Integration of virtual care and community-based supports optimises workforce and sustainable use of infrastructure and resources.
- Standardised triage, referral criteria and structured pathways balanced with local needs and resources ensure ‘right care, first time’, regardless of geography.
- Virtual models extend access to rural and regional communities.
- Expanding access to allied health assessment and treatment provides a cost-effective option for patients to receive care.
Key principles for conservative-first care
Based on statewide findings and high-performing models, the following principles underpin a consistent, effective conservative-first approach.
A single musculoskeletal and orthopaedic care entry point (‘front door’)
- Centralised triage for common MSK presentations, e.g. hip, knee, shoulder, back and others, where appropriate.
- Conservative care offered as the default pathway, with escalation to surgical and/or chronic pain teams, when indicated.
Allied health-led assessment and triage
- Physiotherapy-led screening supported by clear clinical governance and escalation pathways.
- Extended scope roles, e.g. ordering imaging, where feasible.
Multidisciplinary, holistic conservative care
- Integration of physiotherapy, occupational therapy, dietetics, psychology, nursing and virtual care.
- Consistent patient education, lifestyle modification and self-management support.
- Longer consult times, particularly for allied health-led models, enables more holistic care; improves shared decision-making.
Strong links across the musculoskeletal and orthopaedic continuum
- Clear and documented referral pathways into and out of chronic pain services, surgical optimisation programs, pre-admission clinics and post-operative rehabilitation.
- Use of Hospital in the Home, virtual rehabilitation, group programs and community maintenance supports.
Data, outcomes and system visibility
- Routine collection of standardised patient-reported outcome measures, process indicators and surgical outcomes to demonstrate impact and support sustainability.
- Consistent use of statewide tools, such as the Health Outcomes and Patient Experience platform and SRC.
Scalable governance and funding
- District-wide governance to drive consistency and reduce variation.
- Executive sponsorship and endorsement.
- Cross LHD and SHN application with support and integration across all teams.
- Stable funding models that support workforce continuity and scale.
Opportunities for local health districts and specialty health networks
By adopting consistent conservative-care pathways, LHD and SHN executives can strengthen musculoskeletal and orthopaedic care, improve patient outcomes and experience, and reduce surgical pressure. The findings provide a strong platform to:
- build or strengthen centralised MSK and orthopaedic entry points
- expand allied health-led triage
- scale successful conservative models, e.g. OACCP, shoulder and spine triage, virtual pathways
- improve integration across the surgical journey
- use statewide levers, including Statewide Referral Criteria, virtual care, surgical access policy changes and same-day surgery programs.
We support knowledge sharing and system learning related to statewide integrated orthopaedic care pathways.